Intended for healthcare professionals


Urgent care in England

BMJ 2013; 347 doi: (Published 25 November 2013) Cite this as: BMJ 2013;347:f7046
  1. Martin Roland, professor of health services research1,
  2. Adrian A Boyle, consultant in emergency medicine2
  1. 1Cambridge Centre for Health Services Research, General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
  2. 2Emergency Department, Addenbrooke’s Hospital, Cambridge, UK
  1. mr108{at}

Report proposes superficially attractive demand management strategies but fails to deal with fundamental problems

A report on the future of urgent care in England proposes better support for self care, improved access to care outside hospital, and better care for the most serious conditions in a reduced number of “major emergency centres.”1 The report seeks to deal with the problem of rising demand in emergency departments and focuses on reducing demand. However, demand is not the whole problem,2 and a recent BMJ editorial concluded that pressure in emergency departments is caused more by seriously ill patients than by “minor” patients who could be treated elsewhere.3 The focus on demand management also ignores the problems caused by falling bed capacity in hospitals and the inability to discharge patients for lack of community support. A King’s Fund report highlighted delayed discharges and poor bed availability as major reasons …

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